In the letter, Senate Democrats blast HHS's draft Plan for reversing course on a number of priorities from previous Strategic Plans, suggesting the Department is not interested in prioritizing the health care of women, LGBTQ individuals, racial and ethnic minorities, and other vulnerable populations, but rather is intent on advancing extreme, ideological viewpoints and certain religious perspectives over science-based programs and health care.

"If implemented as proposed, this draft Plan would further advance efforts by the Trump Administration to roll back progress in access to health care and undermine protections for vulnerable populations," wrote Senate Democrats. "The mission of HHS is to 'enhance and protect the health and well-being of all Americans.' This draft Plan fundamentally fails to recognize the needs of people across the country. Instead, it is a troubling continuation of policies since the beginning of the Trump Administration to limit the rights of and access to health care for women, LGBTQ individuals, racial and ethnic minorities, and others."

Senate Democrats point out several notable omissions in the draft Plan regarding access to and improvement of health care for vulnerable populations, including:

* No focus on helping women avoid unplanned and unwanted pregnancies;

* Not ensuring that women have access to the health care needed for their own health and in order to successfully carry out a healthy pregnancy;

* Failing to acknowledge that women face a range of unique health needs, such as higher risk of heart disease and certain cancers; and

* Eliminating support for LGBTQ individuals and partnerships with tribes and with American Indian, Alaska Native, and Native Hawaiian communities.

We write to express our deep concerns with the Department of Health and Human Services' (HHS or "the Department") draft Strategic Plan for FY2018-2022 ("the draft Plan") released on September 26, 2017. The draft Plan consistently prioritizes ideology over science and fails to address the diverse health needs of the people the Department serves. If implemented as proposed, this draft Plan would further advance efforts by the Trump Administration to roll back progress in access to health care and undermine protections for vulnerable populations.

The draft Plan reverses course on a number of priorities from the previous Strategic Plan, suggesting the Department is not interested in prioritizing the health care of women, LGBTQ individuals, racial and ethnic minorities, and other vulnerable populations, but rather is intent on advancing extreme, ideological viewpoints and certain religious perspectives over science-based programs and health care. Meanwhile, there are notable omissions in the draft Plan regarding access to and improvement of health care for vulnerable populations.

The only mention of women in the draft Plan is in the context of pregnancy and childbirth. The draft Plan does not focus on helping women avoid unplanned and unwanted pregnancies. Further, the Plan does not ensure that women have access to the health care needed for their own health and in order to successfully carry out a healthy pregnancy. The draft Plan also fails to acknowledge that, in addition to reproductive health, women face a range of unique health needs, such as higher risk of heart disease and certain cancers. Instead, in repeatedly stating that life begins at conception, the draft Plan imposes certain ideological views on all individuals, fails to account for a woman's right to control her own reproductive health decisions, and runs counter to well-established constitutional caselaw.[1] The concept of life beginning at conception has not been mentioned in previous strategic plans, dating back to at least 2000.[2] We do not believe that it is within HHS's purview or the public interest for the Department to enforce religiously-backed, ideological policies and interventions, especially those without the backing of scientifically vetted studies.

In the draft Plan, the language from previous strategic plans about support for LGBTQ individuals is eliminated altogether. Past strategic plans have talked about significant disparities that persist in key health indicators in certain populations, including for LGBTQ youths and adults. For example, the FY 2001 Strategic Plan stated, "Despite major advances in health care in the United States, significant disparities persist in key health indicators across all racial and ethnic groups. Similar disproportionate health risks may exist for other populations, such as gay, lesbian, and bisexual youths and adults. The elimination of these disparities is a major focus of HHS initiatives."[3] The FY2010-2015 and FY2014-2018 Plans included similar language.[4]

Also absent from the draft Plan are efforts to prioritize minority groups who face some of the nation's worst health outcomes. Previous strategic plans, including those implemented through the George W. Bush Administration, included objectives to support revitalization efforts in distressed communities, including the development of economic opportunities and strengthening community institutions and local health delivery systems. The FY2007-2012 Strategic Plan even included a special section to focus on reducing health disparities, identifying opportunities for improvement mainly focused on access to care.[5]

Previous strategic plans have promoted partnerships with tribes and consistently recognized states and tribes jointly in nation-wide health promotion efforts. The draft Plan includes only one reference to tribes in a section about mental health and substance use disorders.[6] While coordination with American Indian, Alaska Native, and Native Hawaiian communities in this one area is important, so too are a number of other areas recognized in past plans to integrate them the broader health care system.

The mission of HHS is to "enhance and protect the health and well-being of all Americans."[7] This draft Plan fundamentally fails to recognize the needs of people across the country. Instead, it is a troubling continuation of policies since the beginning of the Trump Administration to limit the rights of and access to health care for women, LGBTQ individuals, racial and ethnic minorities, and others. We strongly encourage the Department to revise the draft Plan to recognize its responsibility to protect the health and well-being of all the people we serve.

[1] HHS Strategic Plan, FY 2018 - 2022, Draft September 2017, Lines 60-61: "HHS accomplishes its mission through programs and initiatives that cover a wide spectrum of 61 activities, serving and protecting Americans at every stage of life, beginning at conception;" Line 829-831: "Enhance international preparedness through medical countermeasures and community mitigation measures, respecting the inherent dignity of persons from conception to natural death;" Lines 846-848: "A core component of the HHS mission is our dedication to serve all Americans from conception to natural death, but especially those individuals and populations facing or at high risk for 848 economic and social well-being challenges, through effective human services;" Lines 1142-1144: "The research pursued under this strategic goal is to be conducted consistent with the understanding that human subjects protection applies to all human beings from conception to natural death;" and Lines 1341-1344: "Support a broad and diverse portfolio of biomedical research by supporting a range of scientific disciplines, including basic and translational research, to augment scientific opportunities and innovation for public health needs, consistent with human subject protections, which protect all persons from conception on, and bioethics."